Quantum Sufficit

Just Enough

Sarah Evans

Heather McNeill

Am Fam Physician. 2004 Jan 15;69(2):263.

Where there is depression, there also may be chronic pain. As published in Internal Medicine News, reports on the findings of a survey presented at the American Psychiatric Association's annual meeting indicate that two thirds of patients with major depression also have chronic pain. In the study of 5,808 primary care patients, 7.6 percent of patients were diagnosed with major depressive disorder. Of those patients, 26 percent reported chronic, nondisabling pain that lasted at least six months, and 41 percent reported chronic, disabling pain. The findings suggest that remission of major depression in these groups may be more difficult to achieve because antidepressant therapy typically does not address chronic pain.

Mortality from prostate cancer is decreasing. According to American Cancer Society statistics published in USA Today, mortality rates for prostate cancer have dropped by about 33 percent in North America and by 20 percent in Europe since 1990. Reported factors in the improved survival include earlier detection and better surgical and radiologic treatments. One researcher from Oxford University noted that accumulated evidence from several studies indicates that immediate hormone therapy is a vastly underrated factor in the improved survival.

New mothers may need to be reminded to take care of themselves. As reported in Family Practice News, survey findings show that women often neglect their health for a year after a new baby arrives. The surveys of 259 low-income women, completed immediately after delivery and one year later, included questions on 42 health-related items (diet, exercise, alcohol use, sleep/rest, etc.). After a year, behaviors in 11 of the areas had worsened significantly. Change was most significant in behaviors related to eating patterns and nutrition, smoking, and alcohol use.

How U.S. medical students will live is affecting what they choose to do. According to a study published in JAMA, “controllable lifestyle” accounted for 37 percent of the variability in specialty preference among medical students from 1996 to 2002. The variability in specialty preference increased to 55 percent after the researchers controlled for work hours, income, and years of training. In this study, 16 specialties were classified as having a controllable or uncontrollable lifestyle. Factors that determined whether lifestyle was controllable were the number of practice hours per week, the number of call nights, and the time for pursuit of avocational activities. The researchers noted that over time the desire for a controllable lifestyle might alter the distribution of physicians by specialty. The proportion of positions in family medicine filled by U.S. medical school graduates decreased by 26 percent between 1996 and 2002.

Health losses from smoking continue to increase, especially in developing countries. A study published in The Lancet indicates that these losses will become even more substantial unless effective interventions and policies are implemented to reduce smoking in men and prevent increases among women. Using lung cancer mortality as an indirect marker for accumulated hazards of smoking, the study estimated that 4.83 million premature deaths were attributable to smoking in 2000 (2.41 million in developing countries and 2.43 million in industrialized countries), with 3.84 million of the deaths occurring in men. Cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer were the leading causes of smoking-related death.